The European Council on Chiropractic Education (ECCE) currently accredits 10 programs throughout Europe and South Africa. It is assumed that ECCE evaluation activities lead to changes to the chiropractic programs but no systematic evaluation as to whether this is true, and the extent of changes has previously been done. The purpose of this study was to obtain feedback from program heads as to whether ECCE evaluation reports facilitated changes/improvements to their programs and to identify their reported changes.


This was a mixed methods audit study using questionnaires with 2 sections. Closed statements requesting the degree of change to each section of the “Standards” based on ECCE evaluation reports (substantial, some, none) were analyzed using frequencies. Written responses identifying the specific changes made based on previous evaluation reports were evaluated independently by 3 researchers using a modified “thematic analysis” approach.


All 10 accredited programs responded. Seven of the 10 programs (70%) reported “some” or “substantial” changes to ≥ 6 sections of the ECCE Standards. The most common section with reported changes was “Educational Program” (8 of 10). “Educational Resources” had the largest number of programs reporting “substantial changes” (4) and was the second most common section to have reported changes. The main themes identified emphasized changes in “infrastructure, equipment and faculty,” “increasing evidence-based practice,” and “instilling a research culture in faculty and students.”


ECCE accreditation processes facilitate changes to the chiropractic programs, particularly in the areas of improved infrastructure and faculty, research, and evidence-based practice.

This content is only available as a PDF.

Author notes

Cynthia Peterson is a professor with the European Council on Chiropractic Education (7850 E Camelback Road #201, Scottsdale, Arizona 85251; cynthia.peterson@cce-europe.org). Joyce Miller is a visiting professor at AECC University College (7850 E. Camelback Road #301, Scottsdale, Arizona 85251; jmiller@aecc.ac.uk). B. Kim Humphreys is a professor emeritus in the Department of Chiropractic Medicine, Faculty of Medicine, University of Zurich (104-4205 Gellatly Road, South West Kelowna, British Columbia, V4T 2K2, Canada; bkimhumphreys@gmail.com). Ken Vall is with the European Council on Chiropractic Education (27 Rhinefield Close, Brockenhurst, United Kingdom SO42 7; kenvall@icloud.com).

Concept development: KV, CP. Design: CP, JM, BKH. Supervision: CP. Data collection/processing: CP, JM, BKH. Analysis/interpretation: CP, JM, BKH. Literature search: CP. Writing: CP, JM. Critical review: KV, BKH, JM.